Real-World Nonmotor Changes in Patients with Parkinson's Disease and Motor Fluctuations: J-FIRST

Hirohisa Watanabe; Hidemoto Saiki; Shih-Wei Chiu; Takuhiro Yamaguchi; Kenichi Kashihara; Yoshio Tsuboi; Masahiro Nomoto; Nobutaka Hattori; Tetsuya Maeda; Yasushi Shimo; J‐FIRST Group

doi:10.1002/mdc3.12939

Real-World Nonmotor Changes in Patients with Parkinson's Disease and Motor Fluctuations: J-FIRST

Mov Disord Clin Pract. 2020 Apr 11;7(4):431-439. doi: 10.1002/mdc3.12939. eCollection 2020 May.

Authors

Affiliations

¹ Department of Neurology Fujita Health University Aichi Japan.
² Department of Neurology, Kitano Hospital The Tazuke Kofukai Medical Research Institute Osaka Japan.
³ Division of Biostatistics Tohoku University Graduate School of Medicine Miyagi Japan.
⁴ Department of Neurology Okayama Kyokuto Hospital Okayama Japan.
⁵ Department of Neurology, Faculty of Medicine Fukuoka University Fukuoka Japan.
⁶ Department of Neurology and Clinical Pharmacology Ehime University Graduate School of Medicine Ehime Japan.
⁷ Department of Neurology Juntendo University School of Medicine Tokyo Japan.
⁸ Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine Iwate Medical University Iwate Japan.
⁹ Department of Neurology and Movement Disorder Research Research Institute for Brain and Blood Vessels-Akita Akita Japan.

Abstract

Background: Nonmotor symptoms (NMSs) of Parkinson's disease (PD) impair health-related quality of life.

Objectives: To identify changes in NMSs during 52 weeks in Japanese PD patients exhibiting motor fluctuations.

Methods: In PD patients with ≥1 NMS and wearing-off, changes in total/subscore of the Movement Disorder Society Unified PD Rating Scale (MDS-UPDRS) Part I and 8-item PD Questionnaire were assessed. Group-based trajectory models were used to characterize longitudinal patterns of MDS-UPDRS Part I.

Results: Data from 996 patients were analyzed. MDS-UPDRS Part I subscores for cognitive function decreased linearly over time. Total and subscores for apathy and lightheadedness on standing significantly deteriorated with fluctuations, whereas other subscores fluctuated without significant deterioration. Changes in the MDS-UPDRS Part I total score correlated with changes in the 8-item PD Questionnaire total score. Based on group-based trajectory models, longitudinal pattern analysis of MDS-UPDRS Part I scores yielded the following 3 separate groups: unchanged (63.8%), deteriorated (20.1%), and improved (16.2%). The improved group had significantly more NMSs at baseline, significantly higher MDS-UPDRS Part I/8-item PD Questionnaire total scores, and modified Hoehn and Yahr scores, and had received treatment for NMSs. The multivariate analysis revealed significant associations between severe motor disability and receiving any treatment for NMSs at baseline and improvement of MDS-UPDRS Part I total scores.

Conclusions: Changes in MDS-UPDRS Part I scores were variable and related to changes in health-related quality of life in PD patients with motor fluctuations.

Keywords: Japan; Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS‐UPDRS); Parkinson's disease; nonmotor symptoms; observational study.